Page 56 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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72. Figure 1.
compared to femoral access. The challenge of TRA in the congenital laboratory lies in variable patient age, size and anatomic abnormalities. TRA has been adopted by many congenital catheterization programs, though the safety and utility have not been studied in this setting.
Methods: Data were prospectively recorded for all patients considered for TRA in a congenital catheterization laboratory. All patients were screened using Allen and/or Barbeau test, and some had additional ultrasound visual- ization of the radial artery. Primary outcomes included suc- cessful TRA, intraprocedural complications, and successful repeat TRA catheterizations (TRACs). Univariable analyses were performed.
Results: From 2016-2018, 41 TRACs were performed in 22 patients (see Figure 1). At initial TRAC, median age and weight were 21.3yrs (range 13.2-53.5) and 77.6kg (49-136.1). Twenty (91%) patients had undergone heart transplantation and were referred for annual cardiac cath- eterization with coronary angiography. Initial TRAC was successful in 20 (91%) patients. Two patients had proce- dural complications during initial TRAC involving cathe- ter entrapment from vasospasm, with one attributed to a brachial loop. Both resulted in conversion to transfem- oral access. Fifteen (68.2%) patients had ≥1 repeat TRAC and 11/15 (73.3%) had ≥1 successful repeat TRAC. Four patients had abnormal radial artery screening during
subsequent catheterization and two patients had techni- cal errors leading to radial artery spasm upon attempted radial artery access. When comparing patients with a com- posite outcome of a procedural complications or abnor- mal screening to those with successful repeat TRA, there was a clinically relevant difference in median radial sheath time at initial TRAC (69.5 minutes [59-146] vs. 52 [34-110], p=0.098). At the second TRAC, patients with a successful repeat TRA had a significantly larger median radial artery size as measured by ultrasound (2.5mm [1.8-2.6] vs. 1.55 [1.4-1.7], p=0.031). There was no significant difference in age, weight, mean procedural ACT, number of catheter exchanges via the radial sheath, or number of radial artery cocktails given between the two groups.
Conclusions: TRA is a viable option for the congenital catheterization laboratory. Operators should be attuned to ultrasound evaluation of the radial artery and reduced radial sheath time as potential means to avoid compli- cations and future radial artery injury. Further study is needed to determine optimal patient selection and strat- egies to reduce risk profile of this approach.
73. UTILITY OF MULTIPLE HYBRID TECHNIQUES TO REPAIR COMPLEX CONGENITAL CARDIAC DEFECTS
Dennis VanLoozen1, John Braucher2, Anastasios Polimenakos1, Zahid Amin1
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205